[Health Column] Therapeutic Diagnostic Methods and Doctor Shopping

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[Asia Economy] It is easy to make a diagnosis when the cause of symptoms is singular and clear. However, when there are multiple suspected causes, the diagnosis must identify the pathological factor most closely related to the patient's symptoms. In such cases, therapeutic diagnosis is used. As the name suggests, it is a diagnostic method where treatment is tried, and if effective, it becomes a definitive diagnosis.

First, therapeutic diagnosis must pose the least harm to the patient. This means that surgery should not be 'tried' first for patients with back pain. Of course, the method of therapeutic diagnosis may vary depending on the patient's symptoms or social circumstances. For patients with mild symptoms or who have ample time for treatment, medication and physical therapy are usually tried first. However, if the patient is suffering from symptoms or has limited time for treatment, more definitive methods such as muscle trigger point injections or nerve treatments may be used first. Additionally, therapeutic diagnosis must be reversible. Since it involves 'trying' diagnosis and treatment, irreversible physical changes must not occur as a result.

The advantages of therapeutic diagnosis are as follows. First, it can clearly identify the anatomical location of the causal relationship. If the patient's symptoms disappear after treatment at a certain point, that location can be set as the treatment point. Conversely, if treatment at the suspected cause does not improve symptoms, this also provides important information for the patient.

Second, by observing the effect on symptoms, prognosis can be estimated. Observing how long the effect lasts after one treatment, how much the pain decreases, whether stronger agents are needed or not, allows the selection of the most suitable medication or treatment method for the patient.

Third, it is advantageous in determining the extent of the lesion and the dosage of the medication used. This is especially useful for potentially risky locations, as narrowing the range and reducing the dosage decreases related complications. Although inconvenient, adjusting the range and dosage and undergoing several rounds of therapeutic diagnosis before more aggressive treatment can minimize possible side effects. In terms of performance, repeatedly conducting therapeutic diagnosis, which corresponds to rehearsals, is often safer for treatment.

Thus, therapeutic diagnosis is not simply 'trying it out.' It is a diagnostic treatment method with many advantages as listed, but it is difficult to apply to patients who do not fully understand the meaning of therapeutic diagnosis or do not agree to the time needed to observe prognosis.

This is especially true in cases of doctor shopping, where patients visit many hospitals without receiving sufficient treatment at one medical institution. Treatment by a doctor includes the process of excluding various causes. However, excessive hospital hopping prevents full utilization of useful information from the therapeutic diagnosis process, which is quite disadvantageous for the patient. To increase the probability of a definitive diagnosis and improve treatment effectiveness, steady patience is required from the patient as well as the doctor. It may be a natural principle that peace of mind brings physical ease.

Park Yongseok, Director of Haengbok Anesthesia and Pain Medicine Clinic

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